Provider Demographics
NPI:1336685262
Name:SAWYERS, SPENSER G (LPCC)
Entity Type:Individual
Prefix:
First Name:SPENSER
Middle Name:G
Last Name:SAWYERS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E DUE WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5201
Mailing Address - Country:US
Mailing Address - Phone:270-991-5923
Mailing Address - Fax:
Practice Address - Street 1:4980 MOUNT OLIVET RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-9668
Practice Address - Country:US
Practice Address - Phone:615-348-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
KY265305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100736040Medicaid